3701-63-01
Medicaid certification appeal process.

(A)
This rule prescribes the procedure for
appeal of proposals by the director of health to deny, terminate or not renew a
long-term care facility's certification as an intermediate care facility or an
intermediate care facility for individuals with intellectual
disabilities for the purposes of participation in the medicaid program
established by Title XIX of the Social Security Act, 49 Stat. 620 (1935), 42
U.S.C. 301 et seq., as amended (1981), and Chapter 5165. of the
Revised Code. The appeal process shall include:

(1)
An opportunity for an evidentiary
hearing, conducted in accordance with paragraph (D) of this rule; and

(2)
An opportunity for an informal
reconsideration if the evidentiary hearing cannot be completed before the
facility's applicable medicaid provider agreement expires.

The director shall not issue an adjudication order of denial,
termination or nonrenewal of a facility's certification until an evidentiary
hearing is completed or a hearing is not requested within the time period
specified in paragraph (D) of this rule.

(B)
The director shall give written notice by
certified mail of any proposal to deny, terminate or not renew a facility's
certification to the facility.

(1)
The notice
shall include a statement of the reasons for the proposal and citations of the
applicable federal regulations. This information may be provided through
incorporation by reference of the relevant statements of deficiencies (United
States centers for medicare and medicaid services (CMS) form 2567). The notice
also shall state that the facility will be afforded an evidentiary hearing or
an informal reconsideration, as applicable, and shall state the time period, as
specified by this rule, for requesting the hearing or
reconsideration.

(2)
A notice of
the opportunity for an evidentiary hearing given after an opportunity for
informal reconsideration has been afforded may incorporate by reference the
reasons for the proposed action and the regulatory citations as included in the
notice of the opportunity for the informal reconsideration. Notice of
deficiencies cited as the result of surveys of or follow-up visits to the
facility conducted after the initial notice may be provided by mailing or
delivering a copy of the statement of deficiencies to the facility.

(C)
If the director offers a
facility an informal reconsideration, the reconsideration shall be afforded if
it is requested in writing within fifteen days of the date of mailing of the
notice of the proposed action. The request shall be accompanied by any written
documentation, arguments or other information that the facility wishes to
present to refute the basis for the proposed action. The director may request
that the facility supplement the initial submission. After considering the
information provided by the facility and any other pertinent material, the
director shall send written notice of the decision on reconsideration to the
facility by certified mail. If the reconsideration does not result in
certification of the facility or the facility does not request reconsideration
within the time period specified by this paragraph, the director shall notify
the facility of the opportunity for an evidentiary hearing on the proposed
action, in accordance with paragraph (B) of this rule.

(D)
The director shall afford a facility an
evidentiary hearing if the facility requests the hearing in writing within
thirty days of the date of mailing of the notice of the proposed action or the
notice of the director's decision on reconsideration, as applicable. The
evidentiary hearing shall be conducted in accordance with Chapter 119. of the
Revised Code.

(E)
Any facility with
respect to which the director has issued an adjudication order of denial,
termination or nonrenewal of certification may appeal the order to the court of
common pleas of the appropriate county, in accordance with section
119.12 of the Revised
Code.